Events, trends, issues, ideas and journalism about health care and health in Kentucky

Sunday, January 12, 2014

Haynes says Obamacare may drive down Ky.'s health ranking initially because so many uninsured have gone undiagnosed

By Al Cross
Kentucky Health News

Kentucky's low health rankings may get lower before they go up, both because of the state's expansion of Medicaid under federal health reform, the secretary of the state Cabinet for Health and Family Services said in a television interview broadcast Sunday.

"We may see our statistics get worse because there are so many people who have gone undiagnosed," but have gained health coverage, will see a health-care provider and learn more about their health, Audrey Haynes said on KET's "Connections" with Renee Shaw.

Kentucky's overall health ranked 45th among the states in the 2013 edition of America's Health Rankings, done by the University of Wisconsin for the Robert Wood Johnson Foundation. Asked when she thought the state's rank would rise, Haynes said, "Hopefully in five years we will have made a pretty sizeable dent," adding she hopes it can be "in the 30s." But she added that other states will also be improving.

Asked if the medical community is prepared to handle hundreds of thousands of newly covered Kentuckians, Haynes said "All the health care providers in the state are really helping us look at our regulatory environment," and how the state might ease rules to provide more care in the existing system.

She said the state's recent expansion of Medciaid coverage for behavioral health, to any licensed provider, will be important because 80 percent of the "frequent flyers" who make repeated visits to emergency rooms have some sort of mental illness.

Shaw's first question was whether the health reforms will eventually cover the 640,000 Kentuckians who were uninsured last year. Haynes said "We want to get as close as possible" to that number, but it will take two to three years and some will choose to pay the federal tax penalty (1 percent of income) rather than be insured.

"We hope that people will take advantage of it whether they agree with it or not," she said. "When it's changed, then we will deal with that."

Most criticism of the state's expansion of Medicaid under federal health reform is that it will have to pay hundreds of millions of dollars to cover the newly eligible, those with incomes between 69 percent and 138 percent of the federal poverty threshold. The federal government is paying all the cost of those enrollees through 2016; in 2017, the state will pay 3 percent, rising to 10 percent in 2020.

"We have done extensive analysis that shows the federal government is basically going to dump approximately $15 billion over the next few years into Kentucky," creating jobs and tax revenue that will cover Kentucky's share of the expansion cost, Haynes said.

We hope our projections are correct," she said, noting that they were developed by independent contractors. "We gave them no guidelines," she said. "We really wanted to have that outside third-party analysis so it would not be a political decision for the governor, but would be a policy and economic decision for him."

Haynes repeated what Gov. Steve Beshear has said: "Kentucky does have the option of saying we can't afford this and do this anymore, but she added, "We are not going to worry about that for this biennium because it is 100 percent funded." The state budget to be approved in the current session of the legislature runs from July 2014 through June 2016. The next governor will take office in December 2015.

Haynes said that as the expansion makes the state healthier, it will make it more attractive to job creators. "Education and health are sort of like the cornerstone of being able to welcome new economic development opportunities to our state," she said.

The interview with Haynes is available online and will be rebroadcast on KET2 Thursday, Jan. 16 at 7:30 a.m. ET and on KETKY Tuesday, Jan. 14 at 8 a.m. ET; Wednesday, Jan. 15 at 6:30 p.m. ET and Thursday, Jan. 16 at 12:30 p.m. ET.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.Republication of any KHN material with proper credit is hereby authorized, but if the republication is longer than a news brief we ask that it contain the first sentence of this paragraph. Thanks!